Provider Demographics
NPI:1689757635
Name:PESSOA, CORNELIA MOURA (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:MOURA
Last Name:PESSOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 WOOLSEY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1973
Mailing Address - Country:US
Mailing Address - Phone:510-486-1700
Mailing Address - Fax:510-486-1133
Practice Address - Street 1:2320 WOOLSEY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1973
Practice Address - Country:US
Practice Address - Phone:510-486-1700
Practice Address - Fax:510-486-1133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF16231Medicare UPIN
CA00G601300Medicare PIN